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Cultural Interventions

During our class facilitation, our group discussed the importance of considering the importance of culture when developing interventions. Among our class there was a general sense of agreement that culture is an important aspect of our lives, even though we did explore some extreme opinions that claimed that multiculturalism is detrimental to society. Before discussing specific cultural interventions, we wanted to gain a better understanding of the classes’ understanding of culture. After obtaining a firm grasp of culture, we then moved on to discuss the field of cultural interventions as a whole. We did this by discussing a website called “Community Tool Box,” but most specifically the section on the website titled “Adapting Community Interventions for Different Cultures and Communities.” We also discussed a review article titled “Tinkering with Perfection: Theory Development in the Intervention Cultural Adaptation Field” (Ferrer-Wreder, Sundell & Mansoory, 2012). Both of these sources provided great framework to discuss the process of tailoring a cultural interventions. After our broad discussion of cultural interventions, we narrowed down our focus on three different cultural interventions and discussed them in three separate groups.

http://ctb.ku.edu/ “Community Tool Box- Adapting Community Interventions for Different Cultures and Communities”
As the title suggests, this website discusses the importance of adapting certain interventions to be culturally-specific. Unlike the “Tinkering with Perfection” article, this website provides a much more simplistic understanding of how to create and adapt cultural interventions. It provided a step-by-step method of determining several aspects of an interventions. It provided a model to determine whether or not an intervention needs to be adapted. One of the key points stressed on this website was the fact that certain interventions can be suitable for all cultures. If an intervention does not need to be manipulated in order to be effective, then the intervention should remained untouched regardless of culture. However, if the website provided suggestions for changing an intervention if it does need to be culturally tailored. In developing these culturally-specific interventions, they made several suggestions. But one of the key principles the authors suggested was cultural relativism and patience. When creating these interventions. Relating to cultural relativism, the authors state, “See things through their eyes. Act accordingly. To do so, you must have a good idea about how those people understand and relate to the world.” The is the overarching theme found throughout this website. Developing these interventions with an ethnocentric point of view is impossible. Pertaining to patience, the authors state, “Working with different cultural groups or in culturally diverse communities presents a challenge even to experienced professionals”. So while creating these cultural interventions can prove to be extremely effective, the process of creating these interventions can prove to be a stressful one.
The class responded mostly positively to this resource. Most felt that this was a good supplementary resource that could be used to understand when and how to develop a culturally specific intervention. Some in the class argued that this website oversimplified the process of adapting these interventions, while others felt that the website did a sufficient job in explaining the importance of cultural interventions.

“Tinkering with Perfection: Theory Development in the Intervention Cultural Adaptation Field” (Ferrer-Wreder, Sundell & Mansoory, 2012)
In this article by Ferrer-Wreder, Sundell & Mansoory they summarize and evaluate nine theories that offer guidance on how to adapt existing Evidence Based Interventions, or EBIs (interventions that have been proven to be effective), for a new cultural group. All of the selected theories stressed the importance of collaboration as part of the adaptation process as well as the need for systematically adapting the intervention using specific steps. Many of the adaptation theories also stressed the importance of using empirical studies and pilot studies to shape the adaptation. Out of the nine theories mentioned in the article, we discussed a few specific theories as a class: Strengthening families, CDC, EVM and ADAPT-ITT. We noted that these models took slightly different approaches to choosing an appropriate EBI. The first two interventions (Strengthening families and CDC) thought that the best way to choose an EBI was to first identify the problem and then choose a pool of possible EBIs that they could use to address the problem. The most appropriate EBI would then be selected from this pool through collaboration with stakeholders and tested on the target population. Based on evidence from the test, the researchers would then make the necessary surface changes needed to adapt the intervention, being careful not to change the intervention’s deep structure. Unlike the first two models, EVM and ADAPT-ITT started with a single intervention and suggested that researchers make both surface and deep changes based on the evidence that they collect from their pilot studies with the target population. Our class discussed the drawbacks and benefits of both approaches, but we mostly agreed that the best way to choose an intervention would be to start with a pool of possible EBIs and make only surface changes to the selected EBI. Making deep changes would probably be more time consuming and it might run the risk of rendering the intervention ineffective. We closed our discussion of this article by discussing how viable it would be to change an intervention according to these theories, and we mostly agreed that while it would be ideal to use these theories it would also be time-consuming and expensive.

Deflecting the Trajectory and Changing the Narrative: How Self-Affirmation Affects Academic Performance and Motivation Under Identity Threat (Sherman, et al., 2013)
In this study, two longitudinal field experiments evaluated whether a values affirmation writing exercise could help lessen the achievement gap between Latino American students and European American students. In the first study, mixed ethnicity middle school students completed multiple value affirmation (or control) assignments as part of their class assignments. Latino Americans, the identity threatened group, in the values affirmation condition earned higher grades than their peers in the control group. Values affirmation assignments had no effect on European American students. The effects from this study lasted for three years, continuing into high school. In study two, the researchers were interested to see how self-affirmation affected the construals of Latino students. They theorized that since self-affirmation focuses the big-picture, it would lead to broadened construals, prevent daily adversity from being internalized as identity threat, and insulate academic motivation from identity threat. Results from the students’ daily diaries showed that self-affirmation, again, had positive effects on Latino American students. Namely, Latino Americans in the experimental condition construed events at a more abstract level and were less likely to have their daily feelings of academic fit and academic motivation undermined by identity threat. In both studies, Latino American students high in ethnic group identification that were in the control group were more likely to earn higher grades than the other Latino Americans in the control group that were not high in ethnic group identification.
During group discussion, we commended the researchers on their research design– they were very careful to make sure both studies were entirely randomized and that the teacher’s were blind to the condition that their students were in. The researcher’s even went as far as to make the layout of the assignments in the control and the experimental condition identical. Moving past this, we discussed whether or not this intervention was culturally tailored. Self-affirmations have been shown to work in individualistic cultures, however many Latino cultures are collectivistic not individualistic. Though this intervention did work, we discussed whether or not a group-affirmation would be more effective– considering the effect that they found with ethnic group identification and academic achievement. We also discussed whether or not we should bother to culturally tailor an intervention that already works for the target population.

“A Culturally Targeted Self-Management Program for African Americans with Type 2 Diabetes Mellitus” (Collins-McNeil et al, 2012)
Diabetes is a disease that disproportionately affects African Americans. Due to this, the researchers sought to create a culturally specific intervention that would seek to reduce and improve the symptoms of diabetes in African Americans. In this experiment, the researchers developed a church-based culturally targeted intervention that sought to improve diabetes self-management in African Americans.
This intervention took place in urban African American churches. There were 12 participants in the study. Besides the intervention taking place in a church, it was a rather simplistic intervention, consisting of diabetes education, stress, management, and, coping skills, and physical activity. But when developing this intervention they did make several culturally specific changes. For example, spiritual coping was included in all the sessions. Another example was that researchers tried to teach healthy eating by showing participants how to create healthy alternatives of their favorite traditional African American meals through “The Diabetes Soul Food Cookbook’(Gaines & Weaver 2006). These are examples of culturally specific aspects of this particular diabetes intervention.
This particular was shown to be successful. There were significant increases in medication adherence, healthy eating, foot care adherence, blood pressure, blood lipids, physical activity and waist circumference.
While this intervention was successful, we discussed as a group the many shortcomings with this intervention. There was a very small sample size, and there was no control group. This made it seem like this was more of a case study than a true experiment. We discussed a variety of ways that there could have possibly been a control group included in this study, like including a religious group receiving the treatment outside of a church setting to see if the church-based culturally targeted interventions are indeed successful.
While there were many limitations to this study, we did agree that this intervention did provide a good starting point. SInce this intervention did produce significant positive results, the concept of church-based culturally targeted interventions can be expanded to include larger sample sizes and control groups. It can also be expanded outside of simply the Christian faith, and into other religious segments of the population.

“Parent training intervention for parents from different cultural backgrounds with children with behavioral problems.” (Cuzzocrea et al. 2013)
The aim of the experiment was to teach parents some basic behavioral management skills and parenting techniques so that they become more aware of their role as an agent of change in their child’s life and their relationship with their child improves. In the study, a group of Italian and Sinhalese parents were administered the parenting skills. And they were selected on the recommendation of secondary schools where the children of these parents exhibited non-compliant behavior. Eventually, 7 Sinhalese couples from medium-low “socio cultural level”, and 7 Italian couples from low “socio cultural” level were selected. They were first asked to fill out a form referring to what behaviors of their children they considered problematic. Then the research was split in 5 stages where there was pre-training, training, post-training, a first follow three months later and a second follow after six months.
The study was culturally relevant because the authors realized that the parenting strategies and what is classified as misbehavior would be different in different cultures (for instance, while Italian parents thought too much television was a problem, Sinhalese parents thought children asking to go out with their friends was problem). However, the main limitation was that the study did not really make use of this difference and the skills administered were same for both the groups. Also, there wasn’t much elaboration or explanation for why there could be this difference between the cultures. They also did not elaborate much on what exactly the teaching skills administered were. Another limitation that our group discussed was not only the extremely small sample size, but also how biased their method of selecting the parents was. They selected those Sinhalese parents who had been living in Italy long enough to be sufficiently fluent in Italian. However, this is not a very good indicator of whether these parents were truly assimilated in the Italian culture, which in turn could be a confounding variable for their inability to establish a healthy relationship with their children as their social identity might be giving them more problem. Hence, they might know the right parenting strategies (as was later discovered in the study as well), but they might need help with other areas of their life that would improve their quality of life overall. It almost seemed like the researchers took language as the criteria to make their job easier (so they would not have to have a translator). Our group, however, did agree that the method of two follow-ups was extremely valuable. Also, it was a good idea to involve both the parents in the study.
Hence, while there were both negative and positive aspects to the study, our group agreed that it is important for interventions to be culturally tailored and while this particular intervention tried to do that, it was not very successful (due to the limitations stated above). One way of improving it could be that instead of focusing on parents’ behaviors and teaching them skills, the intervention could be more focused on the children themselves.